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Abstract The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved. Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn’t allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved. Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth. Key messages: The complex anatomy of furcation area has important bearing on the root surface instrumentation and subsequently on the long term prognosis of periodontally treated teeth. There is a compelling need to understand the intricacies of this specific morphologic zone ,in context of periodontal instrumentation to enhance the effectiveness of local debridement, which is the cornerstone of standard periodontal therapy. Further, the addition of root trunk length & volume to existing classification systems of FI based on horizontal and vertical bone loss, shall prove a meaningful for providing better insights in to treatment planning and the prognostic evaluation of the periodontally involved teeth. [ABSTRACT FROM AUTHOR]

Background: In order to determine whether a method is more successful for treating a grade-II furcation deficiency, this randomized trial will compare demineralized freeze-dried bone allograft (DFDBA) to platelet-rich fibrin with DFDBA. Materials and Methods: Twenty systematically healthy patients between the ages of 30 and 60 with a grade-II furcation were evaluated pre and postoperatively for changes in the modified plaque index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect. Results: The test group significantly outperformed the control group on all clinical and radiological measures. Conclusion: The experimental group improved at both clinical attachment levels and had a higher decrease in probing depth than the control group did.

Hemisection is conservative way of preserving tooth , which is defined as the surgical procedure that involves removal of a weakened root and compromised crown portion which may be affected by periodontal, endodontic, or structural failures. It aims to efficacious atternative modality in the extraced to save multirooted teeth. This treatment option should be considered when caries, resorption, perforation, or periodontal damage is confined to one root, whereas the other root is healthier. As long as, Expected results can be achieved with this treatment by following the proper diagnostic, endodontic, surgical, prosthetic, and maintenance procedures are followed, this treatment can produce. Present study describes the successful treatment two patients with severely damaged mandibular molars through hemisection. The procedure was successfully and the remaining portion of the tooth was restored with a prosthesis. The patients were followed up for several months, and the outcome was satisfactory, with no recurrence of symptoms. Hemisection can be an effective treatment option for preserving a damaged tooth, and this case report demonstrates its successful application in a clinical setting.

Background: In order to determine whether a method is more successful for treating a grade-II furcation deficiency, this randomized trial will compare demineralized freeze-dried bone allograft (DFDBA) to platelet-rich fibrin with DFDBA. Materials and Methods: Twenty systematically healthy patients between the ages of 30 and 60 with a grade-II furcation were evaluated pre and postoperatively for changes in the modified plaque index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect. Results: The test group significantly outperformed the control group on all clinical and radiological measures. Conclusion: The experimental group improved at both clinical attachment levels and had a higher decrease in probing depth than the control group did. [ABSTRACT FROM AUTHOR]

Abstract Purpose Morphological analysis of permanent anterior dentition is essential for achieving an ideal treatment outcome and avoiding unnecessary failure. This study aimed to analyze the morphologies of anterior teeth in the Chinese population in depth. Methods In this retrospective study, 4309 anterior teeth from 401 Chinese patients were investigated using cone-beam computed tomography (CBCT) from 2019–2021. We summarized the morphological characteristics of the anterior teeth in terms of the root length, cementoenamel junction curvature (CEJ-C), root furcation and canal variations. Results We found that the root lengths of the maxillary anterior incisors were similar (13.3 mm), while the root lengths of the mandibular central (12.2 mm) and lateral incisors (13.4 mm) varied significantly (p

Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence.

Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long‐term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical success rate of guided tissue regeneration (GTR) for treating advanced periodontal disease in a large canine cohort. A total of 112 GTR procedures performed from 2003–2021 were retrospectively evaluated, including pre- and post-treatment (3–12 months) periodontal probing depths of 104 treated teeth, dental radiographs of 73 treated teeth, and both diagnostic modalities in 64 treated teeth. Probing depth, radiographically apparent bone height, bone graft material, barrier membrane material, and tooth extraction adjacent to the GTR site were investigated as factors affecting success. Vertical bone defects were evaluated separately from furcation defects. GTR was clinically successful, defined as objective improvement in probing depth, objective decrease in radiographic vertical bone defect, and subjective radiographic gain in bone height in 90.3% of vertical bone defects. Success was significantly associated with the magnitude of initial probing depth and the type of barrier membrane used. GTR was clinically successful, defined as objective improvement in furcation probing and subjective radiographic improvement of the bone in the furcation in 22.2% of furcation defects. When F3 lesions were excluded, GTR was successful in 64.3% of furcation defects. GTR is an appropriate treatment to maintain teeth in the oral cavity of dogs with proper client counseling and patient selection, but it is most likely to be successful in vertical defects.

Purpose: Morphological analysis of permanent anterior dentition is essential for achieving an ideal treatment outcome and avoiding unnecessary failure. This study aimed to analyze the morphologies of anterior teeth in the Chinese population in depth. Methods: In this retrospective study, 4309 anterior teeth from 401 Chinese patients were investigated using cone-beam computed tomography (CBCT) from 2019–2021. We summarized the morphological characteristics of the anterior teeth in terms of the root length, cementoenamel junction curvature (CEJ-C), root furcation and canal variations. Results: We found that the root lengths of the maxillary anterior incisors were similar (13.3 mm), while the root lengths of the mandibular central (12.2 mm) and lateral incisors (13.4 mm) varied significantly (p <.0001). Both the maxillary (16.6 mm) and mandibular canines (15.5 mm) were found to have greater root lengths than the corresponding incisors (p <.0001). The CEJ-C was significantly greater around incisors (2.5 mm) than around the canines (2.0 mm) in the maxilla (p <.0001), while the curvature remained similar in mandibular anterior teeth (1.8 mm). Root furcation was observed in mandibular canines and lateral incisors. Moreover, all types of Vertucci's classification in anterior dentitions were observed, while two other new types were found. Among them, the maxilla was only observed to exhibit types I, II, III, and ST II, while the mandible was found to exhibit almost all types. However, Type I still accounts for the majority of dentitions. Conclusions: Morphological analysis of permanent anterior dentition revealed diversity in the tooth length, CEJ-C, furcation proportion, and canal variations. In general, mandibular anterior teeth showed a more complex structure than maxillary teeth. [ABSTRACT FROM AUTHOR]

Hemisection is conservative way of preserving tooth, which is defined as the surgical procedure that involves removal of a weakened root and compromised crown portion which may be affected by periodontal, endodontic, or structural failures. It aims to efficacious atternative modality in the extraced to save multirooted teeth. This treatment option should be considered when caries, resorption, perforation, or periodontal damage is confined to one root, whereas the other root is healthier. As long as, Expected results can be achieved with this treatment by following the proper diagnostic, endodontic, surgical, prosthetic, and maintenance procedures are followed, this treatment can produce. Present study describes the successful treatment two patients with severely damaged mandibular molars through hemisection. The procedure was successfully and the remaining portion of the tooth was restored with a prosthesis. The patients were followed-up for several months, and the outcome was satisfactory, with no recurrence of symptoms. Hemisection can be an effective treatment option for preserving a damaged tooth, and this case report demonstrates its successful application in a clinical setting. [ABSTRACT FROM AUTHOR]

Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA), Biodentine with and without Bioactive glass (BG) as furcation repair materials by ultraviolet (UV) spectrophotometric analysis. Materials and Methods: Forty extracted human maxillary molars (n = 40) were selected and decoronated 3 mm above the cementoenamel junction and 3 mm below it and a defect in furcation was created. The samples were then divided into 4 groups of 10 (n = 10) each, Group I: MTA, Group II: Biodentine, Group III: BG + Biodentine and Group IV: BG + MTA and the defect was treated with respective furcation repair material. All the samples were then immersed in 2% methylene blue solution for 24 h and later stored in 65% nitric acid solution. The solution obtained was subjected to centrifuge at 3500 rpm for 5 min. From this solution, 100 μl of the supernatant was collected, analyzed in UV spectrophotometer at 550 nm with nitric acid as the blank and readings were recorded as absorbance units. Results: All four groups exhibited a significant difference in dye absorbance values (P < 0.01). Group I, i.e., MTA showed the least dye absorbance values when compared with the other three groups. Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at P < 0.05. Conclusion: Within the limitations of the study, it can be concluded that MTA had superior sealing ability than Biodentine, whereas BG + Biodentine showed better sealing ability when compared with BG + MTA.

Singular point detection is a primary step in fingerprint recognition, especially for fingerprint alignment and classification. But in present there are still some problems and challenges such as more false-positive singular points or inaccurate reference point localization. This paper proposes an accurate core point localization method based on spatial domain features of fingerprint images from a completely different viewpoint to improve the fingerprint core point displacement problem of singular point detection. The method first defines new fingerprint features, called furcation and confluence, to represent specific ridge/valley distribution in a core point area, and uses them to extract the innermost Curve of ridges. The summit of this Curve is regarded as the localization result. Furthermore, an approach for removing false Furcation and Confluence based on their correlations is developed to enhance the method robustness. Experimental results show that the proposed method achieves satisfactory core localization accuracy in a large number of samples.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P>0.05). However, there was a significant difference for the MTA Angelus group (P

Hemisection denotes a procedure which saves the multi-rooted teeth by endodontic approach of the restorable half and deliberate excision of the compromised tooth structure, as opposed to extraction, that sacrifices the whole tooth. In the present case report, conventional root canal therapy of the root, to be saved, was performed, followed by hemisection of the affected root with the vertical cut method. When complete healing at the surgical site was observed, clinically and radiographically, fixed dental prosthesis was given. Radiographic success observed at recall visit indicated bone formation at the extraction site and the tooth was found to serve normal function. It was a conservative approach aiming to retain as much original tooth structure as possible against the option of extraction of the natural tooth.

Periodontal disease (PD) is the common oral cavity disease recorded in the current study among dogs in Bengaluru. The incidence of PD among dogs with oral cavity diseases was 37.08 per cent. Periodontal disease incidence varies with geography, age, breed, diet and other managemental practices of dogs and it might be possible that PD to vary among dogs with different breeds and geographic regions. Periodontal disease is often found to be associated with renal, hepatic and cardiac diseases. The current study indicated a significant association among PD with renal insufficiency. [ABSTRACT FROM AUTHOR]

The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86–4.6 mm, absorbable membrane groups reported −0.6–3.75 mm, non-absorbable membranes groups reported −2.47–4.1 mm, multiple materials groups reported −1.5–4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of −1.86–2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols' design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported. [ABSTRACT FROM AUTHOR]

This study analyzed the root trunk (RT) and the pre-furcation area (PFA) of mandibular first molars. Thirty lower first mandibular molars extracted due to advanced periodontal disease were evaluated in a high-energy spiral computerized micro-tomography. Two gutta-percha markings on the cementoenamel junction (CEJ) and at the furcation entrance (FE) at buccal and lingual surfaces served as reference points for measurements of RT length, and PFA width and depth, at the levels of CEJ, 1 mm apical to CEJ, 2 mm apical to CEJ, and at the FE. The mean RT length was 2.49 mm at buccal and 3.18 mm at lingual sides. The mean widths of the PFA at CEJ, at 1 and 2 mm apical to CEJ, and at FE were 2.9, 3.4, 3.9 and 4.3 mm, respectively, while the mean depths were 0.19, 0.32, 0.57 and 1.1 mm, respectively. The PFA coincided with CEJ in 10 buccal and 10 lingual surfaces, representing 33.33% of the sample. There was a negative correlation between RT length and PFA dimensions. This study concludes that the RT length was smaller than previous studies. From the CEJ up to the furcation entrance, the PFA showed a progressive increase in width and depth. The coincidence of the PFA area beginning at the CEJ in 1/3, and the negative correlation between RT length and PFA dimensions may represent greater risk factor for the early development of furcation lesions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore general dental practitioners' (GDPs) attitude to periodontal furcation involvement (FI). Materials and methods: An online survey focused on diagnosis and management of periodontal FI was circulated to GDPs in seven different countries. Results: A total of 400 responses were collected. Nearly a fifth of participants reported rarely or never taking 6‐point pocket charts; 65.8% of participants had access to a Nabers probe in their practice. When shown clinical pictures and radiographs of FI‐involved molars, the majority of participants correctly diagnosed it. Although 47.1% of participants were very/extremely confident in detecting FI, only 8.9% felt very/extremely confident at treating it. Differences in responses were detected according to country and year of qualification, with a trend towards less interest in periodontal diagnosis and treatment in younger generations. Lack of knowledge of management/referral pathways (reported by 22.8%) and lack of correct equipment were considered the biggest barriers to FI management. Most participants (80.9%) were interested in learning more about FI, ideally face to face followed by online tutorials. Conclusions: Plans should be put in place to improve general dentists' knowledge and ability to manage FI, as this can have a significant impact on public health. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of 1.2 mg/mL simvastatin (SMV) gel with hydroxyapatite (HA) bone graft in the surgical treatment of mandibular Grade II furcation defects compared with HA bone graft, SMV, and placebo after open-flap debridement (OFD). Materials and Methods: The present study was a single-center, triple-blind randomized controlled clinical trial wherein 23 mandibular grade II furcation defects from 15 chronic periodontitis patients were randomly assigned for treatment with either placebo gel (group 1; n = 5), HA (group 2; n = 6), SMV (group 3; n = 6), and SMV + HA (group 4; n = 6). Clinical parameters at the furcation defect site, such as horizontal and vertical probing depth (HPD and VPD), vertical clinical attachment level (VCAL), radiologic parameters, such as vertical defect depth in intraoral periapical radiograph (IOPA), vertical and horizontal defect depth, and volume of defect in cone-beam computed tomography (CBCT) were recorded at baseline, 3, and 6 months postoperatively and analyzed using SPSS software. For intragroup comparison, paired t test and Wilcoxon test were used, and for intergroup comparison, ANOVA and Kruskal-Wallis test were used. Results: SMV + HA group had improvement in all the clinical parameters when compared to baseline but were not significantly different when compared to other groups. However, statistically significant improvement in HPD was evident in SMV + HA group at 3 months (1.8 ± 1.3; P = 0.019; P < 0.05) when compared to HA group. In CBCT, SMV + HA group had significant improvement in VDD, HDD, and volume of the defect whereas in IOPA, there was no significant findings. Conclusion: Simvastatin with HA is more effective in reducing the horizontal component of grade II furcation defects. [ABSTRACT FROM AUTHOR]

This study aimed to assess the accuracy of diagnosis of vertical furcation subclass in molars using periapical radiographs (PAs) and clinical chartings compared against cone-beam computer tomography (CBCT) as the gold standard. The protocol involved examiners with different levels of experience. This retrospective radiographic study retrieved 40 molar teeth with full periodontal chartings, PAs, and CBCT records. Fifteen examiners with different levels of experience evaluated the PAs and periodontal chartings to assess the vertical depth of furcation and, thus, the vertical subclassification. CBCT was used as the gold standard for comparison. The accuracy of vertical furcal depth measured was assessed together with the accuracy of vertical subclassification assignment. The reliability of the conventional diagnostic modality among the examiners was also evaluated. A linear mixed model adjusted for the CBCT vertical furcal depth measurement was constructed to determine if tooth position, horizontal furcation distribution, and examiner experience level affect the bias in the vertical depth of furcation measurement. The reliability of the conventional periodontal diagnostic method in measuring vertical furcal depth was found to be fair, while vertical subclass assignment was moderate. Significantly better reliability during subclass assignment was found with mandibular molars (p < 0.001) and in maxillary molars with isolated buccal class II furcation. Within the study’s limitations, conventional periodontal diagnostics based on periapical radiographs and clinical periodontal chartings appear to be in poor to fair agreement with CBCT (gold standard) when measuring the vertical depth of furcation. Examiners with the least experience were more prone to bias when estimating the vertical furcal depth.

One of the crucial challenges that any present-day general dentist confronts is the treatment determination between extracting a tooth and placement of a dental implant or by conserving the natural tooth with an interdisciplinary approach. The rising concern amongst the patients towards preserving their dentition has driven the clinicians towards providing treatment options that are more appropriate and conservative and at the same time does not hamper its functional needs. This report highlights one such way of preserving the periodontally compromised natural tooth with just resecting the diseased part of it and also conserving the proprioceptive capacity of the tooth. One-year of regular follow up and maintenance paving way to a healthy periodontium and complete resolution of mobility concerning the affected tooth is described. This report also provides information on root resection in a mandibular molar as a viable and a definitive treatment modality, providing better access to the remaining tooth structure and thereby enabling successive prosthetic rehabilitation.

Combined endodontic periodontal lesion is one of the most challenging dental conditions as making a definite diagnosis and henceforth treatment plan is a daunting task. The prognosis of complex lesion involving both endodontic and periodontic components is complex, but success rate can be improved with regenerative therapies. However, there is paucity of literature regarding its effectiveness in the clinical scenario as only few case reports have been documented in literature for the use of platelet-rich derivatives in regenerative osseous surgery requiring both endodontic and periodontal treatment. We are hereby presenting three cases requiring both endo and perio treatment. The first two cases involve mandibular first molar and maxillary first molar, respectively. The third case involves maxillary central incisor. In all the cases, first, endodontic treatment was initiated, then open flap curettage along with alloplastic bone substitutes was done. Platelet-rich fibrin and platelet-rich plasma were used along with. Three of the treated cases showed significant improvement radiographically and clinically. There was gain in clinical attachment, reduction in probing depth, and radiographic bone fill. Autologous platelet-rich derivative can be used in combination with alloplastic bone substitute for the management of endo-perio cases. Further long-term studies are needed to explore the clinical effectiveness of platelet-rich derivatives and predicting the probability of success of periodontal therapy.

Abstract Background The purpose of this study was to evaluate the effect of the amount of periodontal support on the fracture resistance of root-amputated maxillary molar teeth restored with either direct class. I. restorations or class II. mesio-occluso-distal (MOD) indirect overlay restorations with cuspal coverage. Methods Sixty sound maxillary first molars were collected and randomly divided into four groups. In Groups 1 and 2, MOD cavities were prepared and all cusps were reduced by 2 mm, whereas in Group 3 and 4, only a conservative Class I. cavity was prepared. Subsequently, root canal treatment was performed and the mesio-buccal roots were amputated. Groups 1 and 2 were restored with indirect composite overlay, while Groups 3 and 4 received direct composite fillings. After restoration, teeth were embedded as follows: Groups 1 and 3: normal bone level, Groups 2 and 4: furcation involvement. The specimens were submitted to static fracture resistance testing. Fracture thresholds and fracture patterns were measured and evaluated. Results Group 1 had the highest fracture resistance (2311,6 N) among the restored groups and showed statistically significant difference compared to Group 2 (p = 0.038) and Group 4 (p = 0.011). There was no statistically significant difference in terms of fracture resistance between the rest of the groups. In terms of the fracture patterns, Group 3 was characterized by the highest percentage (60%) of mostly favorable fractures, while the rest of the groups showed predominantly unfavorable ones. Conclusions The amount of periodontal support seems to influence the fracture resistance of root-amputated and restored maxillary molars.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P>0.05). However, there was a significant difference for the MTA Angelus group (P<0.05). Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals. [ABSTRACT FROM AUTHOR]

Objectives: High prevalence of disto-lingual roots (DLR) at the mandibular molar in Chinese can complicate the management of periodontitis. This study assessed the prevalence and morphological features of mandibular first molar DLR and furcation entrances in a Hong Kong population by analysis of cone beam computed tomography (CBCT). Materials and methods: CBCT including the mandibular 1st molar region were identified from the Prince Philip Dental Hospital archive and analyzed by a single investigator. Morphologic features and location of DLR were studied and presented as 95% confidence intervals. Results: A total of 398 CBCTs with 716 mandibular first molars were analyzed. The prevalence of DLRs in mandibular first molars on subject based was 20.1% (95% C.I. 16.2–24%). DLR was located 44.5° ± 8.9° (95% C.I. 42.8–46.1°) to the mid-lingual of the mandibular first molar, with a bucco-lingual width 3.3 mm ± 0.5 mm (95% C.I. 3.2–3.4 mm). The mesial furcation entrance was located 4.0 mm ± 0.9 mm (95% C.I. 3.8–4.2 mm) apical to the cemento-enamel junction (CEJ) while the distal was 5.2 mm ± 1.3 mm (95% C.I. 5.0–5.4 mm) from the CEJ. The surface area of the DLR was 106.9 mm2 ± 41.2 mm2 (95% C.I. 98.9–114.8 mm2). Conclusions: Chinese population has a high prevalence of DLRs. The present information is critical for understanding the morphological features of DLR and guide diagnosis and treatment of stage III periodontitis as well as for secondary prevention and supportive care of stage II periodontitis. Clinical relevance: Little is known about the location and morphology of disto-lingual roots of mandibular 1st molars, yet they are frequently present in patients with Chinese ethnic background, thus complicating diagnosis and treatment. The present study utilized CBCT to analyze the prevalence and morphological features of the mandibular first molar DLR and furcation entrance. It is the first study reporting on the position of the DLR, degree of separation of the furcation, and the surface area of the DLR. [ABSTRACT FROM AUTHOR]

One Of The Most Frequent Iatrogenic Mishaps During Root Canal Treatment Of Posterior Teeth Is Perforation Of The Pulpal Floor During Access Opening/Biomechanical Preparation. It Leads To An Open Communication Between The Root Canal System And The Supporting Tissues Of The Tooth Leading To Formation Of Serous Exudates, Sinus At The Site Of Perforation If Left Untreated. The Development Of Different Techniques And Newer Materials Has Led To Success In Perforation Repairs. The Main Objective Of This Study Was To Evaluate Perforation Repair In Furcal Involving Maxillary Molars In Patients Under 50 Years Of Age. The Current Study Is An Institutional Based Retrospective Study Performed Over Reviewing 86,000 Case Records. A Total Of 14 Subjects Who Underwent Furcal Perforation Repair In Relation To Maxillary Molars Under 50 Years Of Age Were Chosen For The Study Out Of 6475 Subjects Who Had Undergone Root Canal Treatment In Various Teeth. Patients With Other Than Perforation Repairs And Medically Compromised Were Excluded. Once The Data Was Obtained, Analysis Was Done By Descriptive And Inferential Statistics Using Spss By Ibm Version 20. From This Current Study, It Was Found That, Out Of 14 Patients, 9 Males(64.29%) And 5 Females(35.71%) Have Undergone Perforation Repair Treatment. Highest Incidence Of Perforation Repair Was Seen In Tooth Number 26 (42.86%). Patients In The Age Group Of 41-50 Years Had The Highest Incidence Of Perforation Repair In Relation To Maxillary Molars. Adequate Knowledge, Experience And Clinical Skill Enables Good Management Of Furcal Perforations. [ABSTRACT FROM AUTHOR]

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The goal of regenerative periodontal therapy is to completely restore the tooth's supporting apparatus that has been lost due to inflammatory periodontal disease or injury. It is characterized by formation of new cementum with inserting collagen fibers, new periodontal ligament, and new alveolar bone. Indeed conventional, nonsurgical, and surgical periodontal therapy usually result in clinical improvements evidenced by probing depth reduction and clinical attachment gain, but the healing occurs predominantly through formation of a long junctional epithelium and no or only unpredictable periodontal regeneration. Therefore, there is an ongoing search for new materials and improved surgical techniques, with the aim of predictably promoting periodontal wound healing/regeneration and improving the clinical outcome. This article attempts to provide the clinician with an overview of the most important biologic events involved in periodontal wound healing/ regeneration and on the criteria on how to select the appropriate regenerative material and surgical technique in order to optimize the clinical outcomes. [ABSTRACT FROM AUTHOR]

The periodontal ligament (PDL) plays a critical role in providing immediate response to abrupt high loads during mastication while also facilitating slow remodeling of the alveolar bone. The PDL exceptional functionality is permitted by the unique nonuniform structure of the tissue. Two distinct areas that are critical to PDL function were previously identified: the furcation and the dense collar. Despite their hypothesized functions in tooth movement and maintenance, these 2 regions have not yet been compared within the context of their native environment. Therefore, the objective of this study is to elucidate the extracellular matrix (ECM) structure, composition, and biomechanical function of the furcation and the collar regions while maintaining the 3-dimensional (3D) structure in the murine PDL. We identify significant difference between the collar and furcation regions in both structure and mechanical properties. Specifically, we observed unique longitudinal structures in the dense collar that correlate with type VI collagen and LOX, both of which are associated with increased type I collagen density and tissue stiffness and are therefore proposed to function as scaffolds for tooth stabilization. We also found that the collar region is stiffer than the furcation region and therefore suggest that the dense collar acts as a suspense structure of the tooth within the bone during physiological loading. The furcation region of the PDL contained more proteins associated with reduced stiffness and higher tissue remodeling, as well as a dual mechanical behavior, suggesting a critical function in loads transfer and remodeling of the alveolar bone. In summary, this work unravels the nonuniform nature of the PDL within the 3D structural context and establishes understanding of regional PDL function, which opens new avenues for future studies of remodeling, regeneration, and disease. [ABSTRACT FROM AUTHOR]

Background: The combination of collagen in bone grafts is being used because of its properties that accentuate the degree of regeneration. Furcation involvement poses challenge to the prognosis of a tooth, the use of bone grafts and a combination of grafts and membranes have proved to be beneficial in the treatment of furcation defects. Thus, the aim of the present study was to clinically evaluate and compare the effectiveness of collagen fiber bone graft with and without a membrane in the treatment of mandibular Grade II furcation defects. Materials and Methods: A clinical split-mouth randomized control trial, which included ten patients having bilateral mandibular Grade II furcation defects, was randomly assigned to Group I, treated with bone graft of hydroxyapatite with collagen fibers, and Group II, treated with bone graft of hydroxyapatite with collagen fibers and guided tissue regeneration membrane of polyglycolide and polylactide copolymer, respectively. The clinical measurements were recorded at baseline and 6 months after surgery; and plaque and gingival index were recorded at baseline and at 3 and 6 months after surgery. The data obtained was statistically evaluated. Results: The overall results showed that the treatment procedures demonstrated statistically significant reduction in probing pocket depth, vertical defect fill, and horizontal depth of furcation, with a gain in clinical attachment level. On comparison of both the groups, Group II showed superior results with a statistically significant difference in all parameters except in gingival recession. Conclusion: The findings of the study demonstrated superior clinical results obtained with hydroxyapatite with collagen fibers, used in combination with polyglycolide and polylactide copolymer as compared to used alone in the treatment of Grade II furcation defects.

Introduction: Iatrogenic root perforation is a major complication of endodontic and restorative treatments, leading to impairment of tooth prognosis. The aim of this article is to report two cases of successful non-surgical management of lateral perforation using mineral trioxide aggregate (MTA). Case report: This article presents two cases of lateral root perforation due to incorrect post space preparation and iatrogenic cementation of prefabricated posts in the furcation area. A standard disinfection protocol was utilised for the non-surgical root canal retreatment. White and grey MTA were the biomaterials of choice to seal the perforating defects. A novel technique for MTA placement and compaction was applied. The affected teeth were then referred for coronal restoration. Postoperatively, the affected teeth remained asymptomatic and functional. After an 18-month follow-up period, the radiological examination displayed favourable healing outcome and periodontal ligament regeneration in the furcation area. Conclusion: Despite the advances in the endodontic armamentarium, including the application of magnification and the availability of biomaterials, the management of root perforation remains a challenging clinical issue. Apart from effective root canal disinfection and obturation, the intracoronal application of MTA provided an effective seal upon the perforative defects, promoted biological repair and improved the prognosis in two cases of compromised, perforated teeth. [ABSTRACT FROM AUTHOR]

Abnormal caudal regeneration, the production of additional tails through regeneration events, occurs in lepidosaurs as a result of incomplete autotomy or sufficient caudal wound. Despite being widely known to occur, documented events generally are limited to opportunistic single observations – hindering the understanding of the ecological importance of caudal regeneration. Here we compiled and reviewed a robust global database of both peer‐reviewed and non‐peer reviewed records of abnormal regeneration events in lepidosaurs published over the last 400 years. Using this database, we qualitatively and quantitatively assessed the occurrence and characteristics of abnormal tail regeneration among individuals, among species, and among populations. We identified 425 observations from 366 records pertaining to 175 species of lepidosaurs across 22 families from 63 different countries. At an individual level, regenerations ranged from bifurcations to hexafurcations; from normal regeneration from the original tail to multiple regenerations arising from a single point; and from growth from the distal third to the proximal third of the tail. Species showing abnormal regenerations included those with intra‐vertebral, inter‐vertebral or no autotomy planes, indicating that abnormal regenerations evidently occur across lepidosaurs regardless of whether the species demonstrates caudal autotomy or not. Within populations, abnormal regenerations were estimated at a mean ± SD of 2.75 ± 3.41% (range 0.1–16.7%). There is a significant lack of experimental studies to understand the potential ecological impacts of regeneration on the fitness and life history of individuals and populations. We hypothesised that abnormal regeneration may affect lepidosaurs via influencing kinematics of locomotion, restrictions in escape mechanisms, anti‐predation tactics, and intra‐ and inter‐specific signalling. Behaviourally testing these hypotheses would be an important future research direction. [ABSTRACT FROM AUTHOR]

One of the crucial challenges that any present-day general dentist confronts is the treatment determination between extracting a tooth and placement of a dental implant or by conserving the natural tooth with an interdisciplinary approach. The rising concern amongst the patients towards preserving their dentition has driven the clinicians towards providing treatment options that are more appropriate and conservative and at the same time does not hamper its functional needs. This report highlights one such way of preserving the periodontally compromised natural tooth with just resecting the diseased part of it and also conserving the proprioceptive capacity of the tooth. One-year of regular follow up and maintenance paving way to a healthy periodontium and complete resolution of mobility concerning the affected tooth is described. This report also provides information on root resection in a mandibular molar as a viable and a definitive treatment modality, providing better access to the remaining tooth structure and thereby enabling successive prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

Rehabilitation of periodontally compromised dentitions is always challenging in order to restore the masticatory function as well as to prevent future disease progression. This case report discusses an interdisciplinary approach for managing a case of Stage IV periodontitis in a female patient who presented with multiple mobile furcations involved posterior teeth. By a combined endo-perio-prosthetic effort, the retention and rehabilitation of majority of her teeth was achieved. [ABSTRACT FROM AUTHOR]

Background: To investigate the impact of scanning parameter in cone‐beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars. Material and methods: Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed‐parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi‐square tests. Results: The agreement between CBCT FI measurements and intra‐surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362–0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534–0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p <.001). Conclusions: SM of CBCT significantly affect the confidence with FI measurements in maxillary molars. [ABSTRACT FROM AUTHOR]

The aim of the present study was conducted to evaluate the potential of bioinert material, MTA to be used as a regenerative material or restorative barrier in mandibular first molars with grade III furcation defects clinically and radiographically over a 9 month period. The present study was conducted as a prospective single centre split mouth case-control clinical trial in a Dental college and hospital-based setup with a sample of five patients and ten mandibular first molar teeth. Treatment done for all patients was phase 1 periodontal therapy followed by flap surgery where one side open flap debridement was done followed by placement of Mineral trioxide aggregate while open flap debridement alone on the contralateral side. All clinical and radiographic parameters (RVG) were recorded at baseline and repeated after a period of 9 months by a single operator.. It was observed that, clinical attachment loss was reduced to a greater extent in MTA ± OFD (2.2 vs 2 mm, p=0.00) while bleeding on probing scale (1.2 vs 1.4, p=0.004) and probing pocket depth (2.2 vs 2.4 mm, p=0.004) were reduced more in OFD alone group, respectively. Within the limits of this study, the additional benefit of using MTA as a barrier in the mandibular first molar after open flap debridement as compared to open flap debridement was found to be 0.2mm in reduction of CAL and 0.2mm increase of bleeding on probing [ABSTRACT FROM AUTHOR]

Periodontal disease is one of the most common oral diseases which affects the periodontium. Periodontitis is a chronic inflammatory disease of periodontium and it is an advanced lesion characterized by periodontal ligament loss and destruction of alveolar bone. Furcation involvement is a feature of advanced periodontal disease, which increases risk for future loss of attachment and destruction of bone. The furcation of teeth is more prevalent in the molar region. The reason behind this is difficulty to obtain access in the furcation region for self-performed oral hygiene maintenance and complex root anatomy of molars. This study aims to assess the furcation involvement in first molars in the young adult population with periodontal disease. A total of 196 patients with furcation involved first molars within the age group of 18-35 years were included in this study. The study was conducted in Saveetha Dental college and Hospitals. Data were collected by analysing 86000 patients records between June 2019 and March 2020. All the data were recorded and analysed statistically using SPSS software. The results showed that furcation involvement in first molars was seen more in males than the female patients. Based on the severity, grade I furcation defect was present in most of the patients. The present study revealed that the Grade I furcation lesion was commonly observed in both maxillary and mandibular first molars and it is more common in males than females. This study would help to frame clinical practice guidelines for preventive therapeutic measures in maxillary and mandibular first molar teeth in young adults. [ABSTRACT FROM AUTHOR]

Combined endodontic periodontal lesion is one of the most challenging dental conditions as making a definite diagnosis and henceforth treatment plan is a daunting task. The prognosis of complex lesion involving both endodontic and periodontic components is complex, but success rate can be improved with regenerative therapies. However, there is paucity of literature regarding its effectiveness in the clinical scenario as only few case reports have been documented in literature for the use of platelet-rich derivatives in regenerative osseous surgery requiring both endodontic and periodontal treatment. We are hereby presenting three cases requiring both endo and perio treatment. The first two cases involve mandibular first molar and maxillary first molar, respectively. The third case involves maxillary central incisor. In all the cases, first, endodontic treatment was initiated, then open flap curettage along with alloplastic bone substitutes was done. Platelet-rich fibrin and platelet-rich plasma were used along with. Three of the treated cases showed significant improvement radiographically and clinically. There was gain in clinical attachment, reduction in probing depth, and radiographic bone fill. Autologous platelet-rich derivative can be used in combination with alloplastic bone substitute for the management of endo-perio cases. Further long-term studies are needed to explore the clinical effectiveness of platelet-rich derivatives and predicting the probability of success of periodontal therapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the healing events in degree III furcation defects in dogs following the application of the combination of an enamel matrix derivative with a biphasic calcium phosphate (Emdogain Plus). Method and Materials: Seventeen degree III furcation defects, 5 mm high and 4 mm wide, were created in 9 dogs. In both groups, the defects were conditioned with EDTA. One defect was treated with Emdogain Plus (n = 9), while the contralateral defect serving as control remained empty (n = 8). The defects in both groups were fully covered by coronally repositioned flaps. After 5 months of healing, histologic and histometric analysis was preformed. Results: A significant amount of new attachment and bone formation was observed in both control and test specimens. However, in a number of control specimens, ankylosis was also observed. In the control and test groups, respectively, the mean new cementum length was 10.8 ± 2.1 mm and 8.6 ± 3.2 mm; the mean periodontal ligament length was 7.6 ± 3.8 mm and 8.1 ± 4.0 mm. The mean new bone height was 4.4 ± 1.3 mm and 4.3 ± 1.6 mm in the control and test groups, respectively. No statistical differences were found between the two groups in terms of amount of cementum, periodontal ligament, and alveolar bone regeneration. Conclusion: The present study failed to show higher amounts of newly formed cementum and bone following treatment of acute degree III mandibular furcation defects following use of Emdogain Plus compared with a coronally advanced flap. Emdogain Plus seems to have a protective role against ankylosis in this type of defect. [ABSTRACT FROM AUTHOR]

The inter-relationship between periodontal and endodontic disease has aroused much speculation, confusion and controversy. Pulpal and periodontal problems are responsible for more than 50% of tooth loss today. The prognosis of a true combined lesion is often poor or even hopeless, especially when there is extensive periodontal destruction. The present report describes the use of platelet-rich fibrin (PRF) gel and membrane in combination with a bone graft for treating a tooth with a combined periodonticendodontic lesion. The tooth was endodontically and periodontally treated. Clinical and radiographic follow-up was performed after 6 and 12 months. After 1 year, the absence of a interradicular lesion, pain and swelling along with tooth stability and adequate radiographic bone fill indicated a successful outcome. The success of treating a combined periodontic-endodontic lesion depends on patient cooperation, restorability and economics, which help in acting on treatment decisions. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine and compare the incidence, location, and size of accessory foramina in the furcation region of permanent and primary molars. Method and materials: A random sample of 100 extracted human permanent maxillary and mandibular first and second molars (25 teeth of each type) and a random sample of 100 extracted human primary maxillary and mandibular molars (50 teeth of each type) were used. The crowns and roots of each tooth were removed at a point 1.5 mm apical to the external furcation region, and a second cut was made at a point 1 mm apical to the cementoenamel junction. The specimens were examined using scanning electron microscopy at magnifications ranging from x10 to x1,250. The incidence, location, and size of accessory foramina were documented and statistically analyzed. Results: Of the 100 permanent molars examined, 78% had accessory foramina with diameters ranging from 10 µm to 200 µm. Accessory foramina were present in 94% of the primary molars, with diameters varying from 10 µm to 360 µm. The incidence of accessory foramina was significantly higher in primary than in permanent molars. Conclusion: The presence of accessory foramina with large diameters may imply that an inflammatory process can spread from pulpal to periodontal tissues and vice versa. (Quintessence Int 2004;35:699-705). [ABSTRACT FROM AUTHOR]